Kaleb Shane Birney, ATC, LAT, CSS
Individual provider Active NPI Specialist · Dillon, MT
NPI 1144629593 · NPPES record last updated Aug 21, 2014
Key facts
- NPI
- 1144629593
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Specialist 174400000X
- License
- AT-LAT-LIC-1102 (MT)
- Practice address
- 710 S Atlantic St
Dillon, MT 59725-3511 - Phone
- (406) 683-7329
- NPI assigned
- Aug 21, 2014
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT-LAT-LIC-1102 | MT | MD | Specialist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | AT-LAT-LIC-1102 | MT | Yes |
Addresses
Primary practice location
710 S Atlantic St
Dillon, MT 59725-3511
Mailing address
15 Aurora Lane
Dillon, MT 59725-7354
Other providers in Dillon, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 21, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.